Transcript Mike Scott`s Presentation

European Innovation
Partnership on Active and
Healthy Ageing
Medicines Optimisation
Best Practice
Professor Mike Scott
Pharmacy and Medicines Management
Centre
Northern Health and Social Care Trust
Titanic Centre
30th January 2014 Belfast
Time line
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2000-2004 Integrated Medicines Management
(IMM)-patients over 65 years of age
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2005-present Pharmaceutical Clinical
Effectiveness
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2006 - Safer Patient Initiative (International
Healthcare Improvement (IHI) )
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2010- present Innovation Programme
How was it initiated
 Business
case was produced indicating
the work that was proposed
 Resources required to undertake
 Process measures
 Clear outcome measures
 Research base methodology
How Was Political Support
Obtained
 Northern
Ireland Executive Innovation
Fund proposal (1999)
 Citizen
Benefits for older people
predicated on previous local evidence
How was financial support
secured
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Executive programme funds Euro 720k first three
years for the pilot
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Based on positive outcomes further investment
over the next five years Euro 4.8million
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Return on Investment:
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For very 3 euro invested per head of population
15 Euro returned
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Innovation programme 840k Euro
Stakeholder Buy -in
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All relevant stakeholders were involved at the
outset
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Integration of the key healthcare team
members
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In the Pharmaceutical Clinical Effectiveness
Programme there is a multidisciplinary
collaborative approach to reach consensus
on clinical products based on safety and
quality
Implementation of the technical
solution
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Comprehensive education and training
Integration with medical and nursing colleagues in
both primary and secondary care
Standard operating procedure development
Documentation development
Skill mix and role clarity
Software development for both operational use
and process and outcome capture
Robust research based methodology-University
linkage
How change management was
implemented
 Extensive
pre implementation discussion
with all key stakeholder groups
 Workshops and presentations
 Roadshows
 Oversight group
 Operational group
AIM
 To
optimise the benefits that patients gain
from prescribed treatments through
innovative technology-supported solutions
delivered through intra professional and
intra sectoral systems change
Medicine Optimisation Objectives
Right Drug
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Selection
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Matrix methodology
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STEPSelect (Safe Therapeutic Economic
Pharmaceutical Selection) optimise acquisition
cost
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Formulary management
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Guideline development
Medicine Optimisation Objectives
Right Patient
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Re-engineered clinical pharmacy services in
the hospital setting (older patients)(EPICSElectronic Pharmacist Clinical Intervention
System)
 Focus on admission ,inpatient stay and
discharge
 Medicines appropriateness index
 Consultant care of the elderly pharmacists in
intermediate and nursing home settings
 Predictive risk modelling in the elderly
Medicine Optimisation Objectives
Right Dose
 Medicines
reconciliation between sectors
(Writemed software)
 Medicines reconciliation between
professionals
 Medicines reconciliation at all transitions of
care
 Development of the Emergency Care
Summary(ECS) and then Emergency Care
Record(ECR)
Medicine Optimisation Objectives
Right Time
to EIP –AHA to improve
adherence to prescribed treatments
 HSC assessment tools
 Adherence solutions both technological
and patient focussed
 e -health strategy
 Development of a technology supported
intervention via the Small Business
Research Initiative(SBRI)
 Commitment
Results (1)
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Reduced length of stay by 2 days
Reduced readmission rate
Reduced length of stay on readmission 5.8 days
Improved Medicines Appropriateness Index (17.48
to 5.69)
Reduction in 4.2 errors per admission kardex
Reduced medicines administration error rate(8.3%
to 1.3%)
Reduced discharge error rate from 22% to less
than 1%
Results (2)
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Nursing home:
 Four interventions per patient
 Improved MAI
 Reduced costs of £48 per month per patient
 Reduced ED attendances
 PCE programme achieved 168 million Euro
of efficiency gains
 Improved satisfaction with the system by
patients
Added Value-Integrated working
 Enhanced
communication:
 Between health care professionals
 Between sectors
 Between community and voluntary sectors
 Traditional barriers broken down
Efficiency Effectiveness
Sustainability
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211 pharmacists and technicians have been trained across
sectors
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Northern Trust has a multi faceted adherence service
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Software developments have improved the efficiency and
effectiveness
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In place for 13 years
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Adoption in other countries
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Learning visits testify to the recognition of the effectiveness
and efficiency
Competitiveness Market Growth
Economy
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ENABLING TECHNOLOGIES;
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STEPSelect - Digitalis Ltd Amsterdam
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EPICS(Electronic Pharmacist Clinical Intervention
System) –Yarra Software Ltd Belfast
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Writemed (Medicines reconciliation software
programme) -Yarra Software Ltd Belfast
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Bespoke locker development -Hospital Metalcraft
England
Competitiveness,Market Growth
Economy
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Clinical rules –Digitalis and Orbisch Medisch Centrum
Sittard Netherlands
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Intelligent Alerts - Yarra Software Ltd Belfast
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Local Automated Microbiology Pharmacy Surveillance
System (LAMPS) Yarra Software Ltd Belfast
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Other HCAI related , Iskus Health- Dublin,Arran
Healthcare –Dublin, Goldshield- USA
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Success factors(1)
 Early
stakeholder engagement
 Willingness
to change systems and
processes
 Good
strategic and operational oversight
Success Factors (2)
 Robust
methodology in terms of both clear
process measures and outcomes
 On-going reports and dissemination of
progress including conferences and
publications
 Development of enabling technologies
 Quality improvement model of change
Success Factors (3)
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Better engagement with researchers
 Better values and outcomes though
engagement with Pharma
 Concordance improvement though
partnerships with patients and carers
 Improved dialogue with the technology
industry
 Utilisation of Government innovation
incentives in pursuit of the health and well
being agenda
Barriers to innovation
 Underdeveloped
pharmacy service
focussing on distribution rather than
patient facing
 Lack of awareness of current system
deficiencies by other healthcare
colleagues and the skill set of pharmacy
 Lack of technical staff
 Absence of training material
 Enabling technologies
Transfer Success
 Another
Trust in Northern Ireland
 Regional in Northern Ireland
 Numerous Trusts in England
 Uppsala in Sweden
 Skane in Sweden
 Tallaght Hospital in Southern Ireland
 Drogheda Hospital In Southern Ireland
Education and Training
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Colleagues from
Sweden
Norway
South of Ireland
Erasmus programme with Poland
Programme with the Spanish Hospital Pharmacists
Association
Exchange programme with Orbisch Medisch Centrum
Sittard ,Netherlandss
Jordan
Numerous visits from English Colleagues
New Zealand
Lessons Learnt
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Realistic timelines
 Full stakeholder engagement and ownership
 Ensure that robust measures are determined
at the outset
 Awareness of the difficulties in developing
enabling technologies from both a hardware
and software viewpoint
 The importance of ensuring paper based
methods work before automating
 Identifying commercial partners
Action Plan(A1) Prescription and
Adherence to Medical Plans
 Improve
patient adherence to care plans
 Empower patients and caregivers
 Deliver improvements in the healthcare
system to promote adherence
 Contribute to the research methodology on
ageing and adherence
 Foster communication between different
partners to improve adherence
Work to date
 Delivered
transferrable process changes
in hospital and interface aspects
 Delivered enabling technologies with EU
companies
 Delivered robust evidence
 Delivered enhanced communication
between key partners at transitions of care
 Initiated work on older patients in cohorted
settings in the community
Medicines Management
Support Service Project
 To
improve outcomes form prescribed
medicines by ensuring safety and quality
in provision of adherence support for older
people who are living in their own homes
 NHSCT
and SEHSCT ,Community
Pharmacists
Medicines Management
Support Service Project
 Develop
a referral mechanism
 Refine the assessment tool
 To identify a range of solutions
 Explore feasibility of monitoring and followup
 Develop governance arrangements
 Problems –access,concordance,clinical
Small Business Research
Initiative (SBRI)
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For individual use
For the use of people living in their own homes
Tailored to the individual’s needs
Easy to use
Supported by monitoring and data tracking
Capable of incorporation into patient care
pathways
Capable of interface with HSC ICT systems
EIP
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Valuable potential collaborators to complete
the gap closure
 Enables awareness of other work and a
much more cohesive way to go forward
 Building of links with other groups in your
specific area via EIP members
 Dissemination mechanism
 Formulate research questions
 Bids for Horizon 2020 funding
CONTACT DETAILS
E
mail :
 Drmichael.scott@northern trust.hscni.net